Update on the Mechanisms of Chronic Pain

Better imaging technology has shown us that the brain changes in response to chronic pain. Scientists suspect changes in the structure of both the spinal cord and the brain occur. In fact, there may even be changes in the immune system. The result is an ongoing series of pain messages.

This new information has lead to proposed changes in how we treat chronic low back pain patients. Scientists are looking for ways to reverse some of these changes. A new method called deep learning therapy (DLT) is being tried.

With DLT the patient is told the problem is not psychologic. It's neurologic. Then an exercise program is started. The goal is to gradually increase the use of the back. Patients are guided to increase function despite the pain.

A behavioral program is included. Patients are trained to break the hold that fear and anxiety have on them. They are taught how to reduce the attention they put on their pain.

The hope is that with DLT, retraining the painful parts of the body will reorganize the neural anatomy. The results in small studies have been positive. But so far patients have been improved but not cured.

Larger studies are needed to find rehab methods that work for everyone. For now, it's assumed that some things only work for some people. It's always a matter of finding out what works best for each individual. There may be genetic and environmental factors we still aren't aware of that could make a difference. Future studies may bring these to light.

Does Chronic Back Pain Change the Structure of the Spinal Cord and Brain -- And Can Rehabilitation Reverse These Changes? In The Back Letter. April 2007. Vol. 22. No. 4. Pp. 40-41.